Vaginal Hysterectomy/Laparoscopic Assisted Vaginal Hysterectomy

Patient Information Booklet

Please bring this book to your admission to the Hospital and to all of your appointments

For Information Call 613-721-2000 extension 2920

Between 8:00 a.m. and 4:00 p.m. Monday to Friday

Welcome to Queensway Carleton Hospital

Queensway Carleton Hospital (QCH) is a patient and family-centered hospital providing a broad range of services through the dedicated care of healthcare professionals. We look forward to helping you throughout your hospital stay. Please be sure to ask any questions you may have at any time.

Please refer to our Patient Handbook for more information about QCH and what you need to know as a patient while you are here. This handbook will focus specifically on your upcoming hip replacement surgery.

IMPORTANT: If your surgeon or healthcare team gives you different recommendations than what has been provided in this booklet, please follow directions from the surgeon or healthcare team.

Vaginal Hysterectomy/Laparoscopic Assisted Vaginal Hysterectomy

This booklet has been prepared so that you, your family, and all members of your healthcare team know your plan of care, including what tests, treatments and diet you require as well as the education and planning necessary for discharge.

The patient booklet of the Vaginal Hysterectomy/Laparoscopic Assisted Vaginal Hysterectomy gives you an idea of what to expect from when you get to the hospital until discharge.

Once you and/or your family have read the information, please feel free to ask your nurse or other members of the healthcare team any questions.

What happens at the pre-operative assessment visit?

Your visit to the Pre-operative Assessment Clinic (POAC) may involve a 4 to 6 hour visit to the hospital. It is important and mandatory to attend this appointment, or your surgery will be postponed or cancelled. In the clinic you will be officially registered for your hospital admission and a nursing assessment and pre-operative tests will be performed. These tests may include:

X-rays Blood and urine tests ECG (electrocardiogram)

You will be given information about your hospital stay. The Nurse will take your health history and ask you to review your consent for surgery. The most important

things you will learn during your visit to Pre-operative Assessment Clinic (POAC) are:

The date and place for your hospital admission How to prepare for your surgery Deep breathing exercises and ankle exercises

You may see other healthcare professionals during your Pre-operative Assessment Clinic (POAC) visit, if requested by your Surgeon. These may include:

Anesthesiologist Medical Doctor Community Care Case Manager Social Worker Dietician

Please bring the following to your Pre-operative Assessment Clinic (POAC) appointment:

All your current medications in the proper bottles, including non-prescription medications (creams, eye drops, puffers, lotions, vitamins, herbal products)

A list of allergies including type of reaction Provincial health insurance card and proof of any additional health insurance Your substitute decision maker if they have signed the consent for you Your reading glasses if required A translator if you have difficulty understanding or speaking English We recommend that you bring one family member or friend with you to your

appointment who will assist you in your care. This person has to be able to accompany you to your various appointments in the hospital. There is some walking involved.

You will be asked if you smoke or consume alcohol on a regular basis.

MRSA (Methicillin - Resistant Staph Aureus)

Today, many hospitals in Canada and around the world are dealing with bacterium which no longer responds to many antibiotics. Queensway Carleton Hospital is taking steps to prevent and control antibiotic resistant bacterium. This bacterium does not cause problems in healthy people, but it can cause infections in people who have weakened immune systems or have had major surgery. If you have stayed overnight in a health care facility within the last year, you will be screened for this at the time of your POAC visit.

Will I need to see a social worker?A social worker may call if you feel there are any issues that make it difficult for you to manage at home on discharge. If you are already on Home Care through the Local Health Integration Network Home and Community Care (LHIN HCC), please make sure that your care coordinator knows the date of your surgery.

If you live alone, you should plan to have someone stay with you overnight and to help make meals for a few days. You could also make meals ahead of time and freeze them. If you are worried about being alone, you may want to think about convalescent care in a retirement home. You can make these arrangements yourself or we can guide you to do it when you come to Pre-operative Assessment Clinic (POAC).

If you are the caregiver for someone else, please let us know at the time of your pre-operative visit.

Care Partner & Visitor PolicyPlease refer to the QCH Patient Handbook for detailed information about our care partner and Visitor Policy while you are at QCH.

Please ensure that visitors are aware of the Queensway Carleton Hospital scent-free policy. Please do not bring scented flowers to the hospital.

Family contact:

Please discuss and decide with your family who will be the primary “contact” person. This should be the only person to phone the hospital staff regarding your condition. This person can further contact the rest of your family and/or friends. This name will be written on the chart. Please let your family and friends know who this person is.

My family contact is: ____________________________________

Phone numbers: Home: ____________________________________

Work: ____________________________________

Cell: ____________________________________

Where do I go for my pre-operative assessment visit?

Report to Queensway Carleton Hospital main lobby Information Desk. You will be directed to the Patient Registration Department to be registered and then to Pre-operative Assessment Clinic (POAC).

When is my appointment?The Queensway Carleton Hospital Operating Room Scheduling Department will notify you at home of your appointment at Pre-operative Assessment Clinic (POAC).If you have any questions about your appointment please call the Operating Room Scheduling Department, Monday to Friday, 8 a.m. to 4 p.m. at (613) 721-2000, ext. 2614.Your date of surgery is: ________________________________________

Call the Queensway Carleton Hospital Operating Room Scheduling Department on the day before your surgery is scheduled to get the time for your admission. The number to call is (613) 721-4840 between 11 a.m. and 3 p.m., Monday through Friday.Call for your admission time on: _________________________________

(yy/mm/dd)On the day of your Pre-Operative Assessment Clinic visit we advise you to purchase 2 scrub brushes of Chlorhexidine 4% soap. They can be purchased at the Queensway Carlton Hospital Gift Box on the main floor next to the front lobby.

QCH Gift Box HoursMonday to Friday 9 a.m. to 8 p.m.Weekends 12 p.m. to 4 p.m.

Health tips before surgeryWe ask that you check your temperature regularly during the last three days before the date that you are scheduled for your operation. If you feel feverish (temperature 38ºC or 100.4ºF) or develop a respiratory infection during this period, you should notify the Surgeon performing your surgery. This is important for your well-being and the safety of others because there is a risk for everyone if you go into surgery with an infectious process in progress. Should your surgery be delayed, every effort will be made to have you rescheduled as soon as possible.

NOTE: Notify your surgeon before your surgery if you develop a cold or any other illness.

Accommodations for out of town patients and families

If you need to stay at a hotel before or after surgery, please refer to the QCH Patient Handbook for some suggestions.

A short stay at a retirement home may be an alternative for family members who are seniors. Your nurse in the Pre-Operative Assessment Clinic will have a list of retirement homes that offer this service.

What should I bring to the hospital? A knee length dressing gown which opens all the way down the front Non-skid slippers Comfortable clothing. For example: jogging pants or shorts and a shirt, to

wear home Toothbrush, toothpaste, soap, shampoo, deodorant, tissue. These items are

not supplied by the hospital Please label any equipment brought from home with your name All your current medications in the proper bottles, including non-prescription

medications A list of allergies including the type of reaction

Enhanced Recovery Program for Gynecological SurgeriesPatient InformationAt Queensway Carleton Hospital, our goal is to manage your pain and nausea after your gynecological surgery. Enhanced recovery means that you are able to eat and move around sooner and may help to reduce the possibility of lung infections and blood clots. Many patients feel well enough to go home after one day in hospital and may be able to return to work sooner.

Before surgery You should be eating healthy foods up to bedtime on the day before surgery.

Have a high protein snack at 11 p.m. the night before surgery (for example: crackers and cheese, toast and peanut butter, egg and toast)

DO NOT eat solid food (anything you have to chew) after midnight DO drink 1 cup (250 mL or 8 ounces) of clear fluids or (anything you can

see through) before you leave to come to the hospital (for example: Gatorade™, ginger-ale™, apple juice, water). Do not drink coffee, coke™, or orange juice

You may be given Tylenol™ and Celebrex™ at the hospital while waiting for your surgery

How do I prepare for my surgery?You must follow these rules, or your surgery may be cancelled:

Do not eat any solid food after midnight the night before your surgery. If you are thirsty, you may drink clear fluids until you leave to come to

the hospital. Please drink one cup (250 mLs or 8 oz) clear fluid either apple juice,

water or ginger-ale™, before leaving to come to hospital.

You should take your regular prescription medications (no vitamins or herbal products) with water the morning of surgery as advised by the nurse or doctor you spoke with in POAC. Bring your medications including any inhalers with you to the Hospital.

You must stop taking all supplements except vitamin D, calcium, or iron/iron supplements one week before surgery.

If you are taking Aspirin or other blood thinners, please inform your surgeon or nurse. You will be given specific instructions. Skin preparation:Stop shaving in the operative area one week (7 days) before your surgery date. Shaving can cause tiny nicks in the skin that may allow germs to enter your body and cause an infection. Do not use bath scents, powders or body lotions.

The night before surgery bath or shower and wash your entire body using the Chlorhexidine sponge. Pat yourself dry with a fresh clean soft towel, put on clean pajamas or clothes and put on freshly laundered bed linens on your bed if you are able.

The morning of surgery repeat your bath or shower using the Chlorhexidine 4% soap sponges. (Chlorhexidine 4% soap sponges are available at the QCH Gift Box)

If you are a smoker, stop smoking at least 24 hours before your surgery. We can provide you with smoking cessation support to prevent nicotine withdrawal during your hospitalization.

Do not drink alcohol at least 24 hours before surgery. On the day of surgery do not apply deodorant, powders, and body lotions or

insert contact lenses. Please do not wear any scented products because some people are allergic to them.

Do not bring valuables (jewellery, credit cards, and money) to the Hospital. We do not assume responsibility for lost or stolen articles.

Arrange for someone to drive you to the Hospital the day of surgery and drive you home on your discharge day.

During Your Hospital Stay

When you arrive at the hospital

Report to the Patient Registration Desk on the main level. Please bring your health card, insurance cards and this booklet. Please do not bring valuables to the hospital

From Patient Registration, you will be directed to the Day Surgery Unit (DSU). One care partner can accompany you and stay with you once you are admitted. You may designate this care partner to be the person to call after surgery

Staff will show you where to change into a hospital gown. Your clothes will be placed in a bag for transfer to your room. You will then lie down on a stretcher

Your nurse will start an IV and will give you any needed medications You will talk to your anesthesiologist and surgeon before your surgery. The

nurse will start an intravenous by inserting a small needle into your arm or hand. Medication and intravenous fluids are given through this needle. You may receive a spinal anesthetic

In DSU, you will be covered with a special blanket to keep you warm. This will be removed before taking you to the OR. Keeping you warm helps to prevent post operative infections

During surgery

You may be offered a spinal anesthetic (freezing medicine that is put into your back) or a general anesthetic

You will be given an anesthetic medication Your anesthesiologist will discuss these with you prior to your surgery

After surgery: Recovery Room

Your operation can last from 1 ½ to 2 ½ hours You are moved from the Operating Room to the Post Anesthetic Care Unit

(PACU) You may have an oxygen mask or nasal prongs on your face. You may

require oxygen for 24 hours following surgery You may have a catheter in your bladder to drain your urine Your nurse monitors your vital signs, including your pulse and blood

pressure and will look at your incision frequently

Your nurse will check the circulation, sensation and movement of both legs. Your legs will feel heavy and will be difficult to move for a few hours after the spinal anesthetic. They will slowly return to normal

If you feel any pain, nausea or itchiness tell your nurse. You will be given medication to help you feel better

You may be drowsy after the surgery, as you become more alert, we will encourage you to do ankle exercises and deep breathing exercises (see below). These exercises will help to prevent post-operative complications

You will be transferred to your room when your nurse determines it is safe to move you and when your room is ready. Sometimes there are delays due to the late discharge of other patients

You will then be transferred to your room on the inpatient unit. Your family will be able to visit you after you are admitted to your room. They can bring in your luggage and equipment at that time

What are ankle exercises and deep breathing exercises?

Ankle exercises:Point your toes toward your head, then towards the foot of the bed. Make your feet go around in circles 5 times. This should be at least every hour while you are awake.

Deep breathing exercises:Take a deep breath in through your nose and slowly blow out through your mouth. Repeat this 3 times. This should be done every hour while you are awake for the first day, then every 2 hours for the next 1-2 days.

After surgery: the inpatient unit

You will be moved to your room. You will have an IV (intravenous) in your arm to give you fluids

You will be getting out of bed the evening of your surgery. Walking and exercise are a vital part of your recovery

The nurse call button will be within your reach so you can push the button if you need assistance

You will be encouraged to eat small amounts if you are hungry You may be given pain medications (Tylenol™ and Celebrex™) that should

be taken on a regular schedule whether you have pain or not Pain or nausea medications will be available if you need them You will likely feel well enough to go home on the first day after surgery

Protecting your skin from pressure injuries

During and after your surgery you are at risk for developing a pressure injury (bed sore, pressure ulcer). A pressure injury is skin breakdown that develops, usually over the tailbone and the heels, from sitting and lying in the same position for long periods of time or from sliding down in bed. Some key things that can be done to protect your skin are: avoid sitting in bed with the head of the bed higher than 30 degrees for long periods of time. Reposition yourself or ask for help about every 2 hours, when you turn on your side put a pillow between your legs and when you lie on your back. Use pillows under your lower legs, so your heels “float” off the bed.

Operative Site For laparoscopic surgery – you will have several small incisions with self-dissolving sutures covered with a clear plastic dressing and Steri-Strips™. It is normal to have a small amount of old blood on your dressing. You will be advised when to change your dressing. If the incision (s) is wet, clean incision with mild soap and water, gently towel dry and apply 4x4 gauze or Band-Aid™ to the incision. The clear plastic dressing and Steri-Strips™ could stay on for 5-7days.

After discharge from hospital Continue to use Tylenol™ and Ibuprofen (Advil)™ on a regular basis for the

first few weeks If you have a prescription for a narcotic medication, use this as needed if the

Tylenol™ and Ibuprofen (Advil)™ are not managing your pain Eat and move around based on how you feel. Avoid any heavy lifting or

driving in the first few weeks You will need about 4 to 6 weeks to feel like you did before your surgery Drinking fluids helps prevent constipation, as well as eating fruits and

vegetables Call your doctor or come to the Emergency Department if you have a fever

or increased pain For laparoscopic surgery you will need to purchase one box of 4 x 4 gauze

or a small box of Band- Aid™ at a drug store, it is best to purchase these before your surgery to have available at home

If surgery has been done laparoscopically, it is normal to have abdominal bloating for several days. You may also notice pain in your shoulder, under your ribs or in your back

If you have nausea and vomiting you may take Gravol™ to relieve the vomiting

Call your surgeon or go to your nearest Emergency Department if you have any of the following:

Elevated temperature (38°C or 100.4°F) and/or chills lasting more than 24 hours

Drainage/discharge yellow-green pus like, foul smelling Increased redness or swelling of the incision sites Continued or increased pain Excessive bleeding

Pain Management

Please see the booklet “Pain Management after Surgery”.

Adequate pain management is very important for your quick and speedy recovery. Good pain management is needed in order for you to be able to participate in physiotherapy and early walking. It is very important to take your pain medication in order to be comfortable enough to move about as required. The exact amount of pain medication needed will vary between individuals.

Your anesthetist is responsible for pain management during the first 24 hours after surgery. Your pain regimen may consist of several parts. Your anesthetist will determine with you what type of pain management you will receive. Some side effects of pain medicines are: constipation, nausea, vomiting, drowsiness and being itchy. Tell your nurse if you have any of these symptoms. Ask your nurse for pain medication if you are uncomfortable. Your nurse will ask you to rate your pain according to a ruler as outlined below. You will be discharged home with a prescription for medication to manage your pain.

Pain scale ruler

Your nurse will ask you to rate your pain on either the number or FACES scale (see below). Pain is rated from 0 (no pain) to 10 (worst pain).

What should I eat?

Good nutrition promotes healing, helps fight infection and ensures a smooth recovery.

Eat well with Canada’s Food Guide Enjoy a variety of food from all four food groups:

Vegetables and fruits Grain products Milk and alternatives Meat and alternatives

Emphasize whole grain cereals and breads Choose iron-rich foods and a Vitamin C source at every meal

Process Pre- AdmissionAssessment You will be assessed by another physician if requested

by your surgeonTests You will have laboratory tests (blood and urine)

You may have a chest x-ray and electrocardiogram, if ordered by your physician

Medications Please bring your medications in and we will review them

Nutrition We will review food allergies or food sensitivities you may have

Rest and activity You will be asked to have a shower or a bath at home the morning of your surgery

Education Please review this patient booklet that you have been given

Discharge planning

We will discuss your discharge plans

If you have been diagnosed with sleep apnea bring your machine with you. Process Day of SurgeryAssessment We will check your temperature, blood pressure, heart

rate on a regular basis We will monitor your vaginal blood flow We will assess your vaginal packing, if present We will measure the quantity of fluids

administered/taken as well as your urinary outputTests We will do a blood test Medications We will administer antibiotic medication and pain

medication Treatments You may have a vaginal pack inserted during the

operation We will insert a urinary catheter in your bladder to

monitor your urinary output We will continue to administer fluids through your

intravenous You will be encouraged to perform deep breath &

coughing exercisesNutrition After your surgery, you will be able to have sips of fluids

initially and increased to a regular dietRest and activity You will be able to be up and about after surgery

You will be washed after your surgery You will be assisted to dangle and stand at the side of

the bed after your surgeryEducation We will review with you the importance of performing

deep breathing & coughing exercises after your surgery We will review the need to have good pain control to

improve your recovery. If you experience more pain or nausea, please inform your healthcare provider

Discharge planning

You will have your urinary catheter removed in the early morning and will be going home before 10 a.m. on the morning after your surgery

Plan for discharge on the morning after your surgery You will need to arrange for a ride before 10 a.m. on

the morning after your surgery